| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $4.83 | $4.83 | $19.55 | |
Sentara
| Facility | $42.50 | $42.50 | $43.44 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $4.83 | $4.83 | $19.55 | |
Sentara
| Facility | $42.50 | $42.50 | $43.44 |